Lirafugratinib (Lyrfigtu™)

Store your medication in the original container with the label. If you want to use a pillbox, talk to your pharmacist. Keep it in a dry place at room temperature unless your provider or pharmacist tells you otherwise. Keep containers out of reach of children and pets.

If a caregiver prepares your dose for you, they should consider wearing gloves or pour the pills directly from their container into the cap, a small cup, or directly into your hand. They should avoid touching the pills. They should always wash their hands before and after giving you the medication. Pregnant or nursing people should not prepare the dose for you. Ask your provider where to return any unused medication for disposal. Do not flush down the toilet or throw in the trash. 

Some cancer medications are only available through specialty pharmacies. Your provider or pharmacist will start this process. Your insurance plan may also affect where you can get your medication.  Call your prescription plan provider to find out which specialty pharmacies are in-network.

This medication may be covered by your prescription plan. If you qualify, you may be able to get financial help through patient assistance programs (PAP). Co-pay cards may also be available to lower your out-of-pocket cost if you have commercial (not Medicare/Medicaid/Tricare) insurance. Your pharmacist, social worker, or navigator can help find resources for financial support.

These are some of the most common or most serious side effects of this medication. Talk with your provider about the side effects you are having and how they can be managed.

Hand-foot syndrome (HFS) is a skin reaction on the palms of your hands and/or the soles of your feet. HFS can be caused by certain chemotherapy agents being absorbed (taken in) by your skin cells. HFS can start as a mild tingling, numbness, pins-and-needles feeling, redness, or pain or swelling of your hands and/or feet. It can lead to painful swelling, blistering, or peeling skin, making it hard to do your normal activities. Tell your providers right away if you have these symptoms, as they may need to change your chemotherapy dose or take a break to let your skin heal. Some ways to help prevent HFS are:

• Keep your hands and feet clean and dry.
• Avoid tight shoes or socks.
• Avoid activities that put pressure on your palms or soles during treatment and for 1 week after treatment.
• Use an alcohol-free moisturizer often, and do not use products with perfumes or scents.
• Do not use very hot water for baths and showers

This medication can cause sores or soreness in your mouth and/or throat, called mucositis. Tell your providers if your mouth, tongue, inside of your cheek, or throat becomes white, has ulcers, or is painful. Medications can be used to manage pain. Regular mouth care can help prevent or manage mouth sores. Some things you can do are:

• Brush with a soft-bristle toothbrush or cotton swab twice a day.
• Avoid mouthwashes that contain alcohol. A baking soda and/or salt with warm water mouth rinse (2 level teaspoons of baking soda or 1 level teaspoon of salt in an eight-ounce glass of warm water) can be used a few times each day.
• If your mouth gets dry, eat moist foods, drink plenty of fluids (6 to 8 glasses), and suck on sugarless hard candy.
• Avoid smoking and chewing tobacco, and drinking alcoholic beverages and citrus juices.

Alopecia is when your hair gets thin, brittle (breaks easily), or falls out. This may happen during the few weeks after treatment starts. Hair loss can be all of your body hair, including pubic, underarm, legs/arms, eyelashes, and nose hairs. You may want to use scarves, wigs, hats, and hairpieces. Your hair helps keep you warm in cold weather, and it can protect you from the sun, so it is important to wear a hat if you are in cold weather or in the sun. If you are going to be out in the sun, protect your scalp by using a sunscreen with SPF 30 or higher. Wash your scalp with a mild or baby shampoo. After you are done with treatment, hair often starts to grow back.

Xerostomia is dry mouth. Dry mouth can be uncomfortable and affect your speech, swallowing, and dental health. Here are some ways to manage:

• Brush your teeth often with fluoride toothpaste.
• Floss once a day, if your provider says you can.
• Chew sugar-free gum or suck on sugar-free candy to help make saliva.
• Rinse your mouth often to keep it moist.
• Ask about gels and rinses that help you make more saliva.

Talk to your provider if you start or continue to have xerostomia. 

Anemia is when your red blood cell count is lower than normal. Red blood cells carry oxygen to the tissues in your body. When your red cell count is low, you may feel tired or weak. Tell your providers if you have shortness of breath, trouble breathing, or pain in your chest. If your count gets too low, you may receive a blood transfusion.

This medication can cause serious infections, with or without a decrease in white blood cell counts.

White blood cells (WBC) help your body fight infection. While you are having cancer treatment, your WBC count can drop, putting you at a higher risk of an infection. Tell your provider right away if you have a fever (a temperature greater than 100.4°F or 38°C), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips for preventing infection:

• Hand washing,  both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (those who have a cold, fever, or cough, or if someone you live with has these symptoms).
• When working outside, wear clothes that protect you, like long pants and gloves.
• Do not handle pet waste.
• Keep all cuts and scratches clean.
• Shower or bathe daily.
• Brush your teeth at least twice a day.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your providers before scheduling dental appointments or procedures.

Ask your providers before you or someone you live with has any vaccines. 

This medication can cause liver toxicity, or liver problems, which your provider may monitor for with blood tests called liver function tests. Symptoms may be:

• Yellowing of your skin or eyes.
• Dark or brown urine.
• Pain in your abdomen (belly).

Tell your provider if you have any of these symptoms.

This medication can cause kidney problems, like an increased creatinine level. Your provider may monitor for kidney problems with blood tests. Symptoms may be:

• Less urine output than normal.
• Blood in the urine.
• Swelling in the ankles.
• Loss of appetite.

Tell your provider if you have any of these symptoms.

This medication can affect your electrolytes (potassium, magnesium, sodium, calcium, etc.). Your electrolyte levels will be checked with blood tests. If your levels get too low, you may be given electrolytes by IV (intravenously through your vein) or by mouth. Talk to your provider before taking any supplements. 

Fatigue can cause exhaustion, feeling worn out and that your body is "heavy" and hard to move, or being unable to focus. It is common when you have cancer, and it is not the same as feeling tired. You may need to adjust your schedule to manage fatigue. Plan times to rest during the day and save your energy for more important activities. Exercise can help lessen fatigue. Talk to your providers about ways to deal with this side effect.

Nutrition is an important part of your care. Cancer treatment can affect your appetite and make it hard to eat. Ask your provider about nutrition counseling services. Some tips you can follow are:

• Try to eat five or six small meals or snacks during the day, instead of 3 larger meals.
• Nutritional supplements may help if you are not eating enough.
• You may have a metallic taste or find that food has no taste. You may dislike foods or beverages that you liked before cancer treatment. These symptoms can last for months or longer after treatment ends.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products, and fish without a strong smell. Sometimes cold food has less of an odor.
• Add extra flavor to meat or fish by marinating it in sweet juices, sweet and sour sauce, or dressing.
• Use seasonings like basil, oregano, or rosemary to add flavor.

Constipation is when you have less bowel movements than usual or are having trouble passing stool. To relieve constipation, you can include fiber in your diet (fruits like prunes, apples, peaches, and pear nectars/juices), drink 8 to 10 glasses of non-alcoholic fluids a day, and stay active. Taking a stool softener once or twice a day can prevent constipation. If you do not have a bowel movement for 2 to 3 days, call your provider. 

This medication can cause high blood sugar in patients with and without diabetes. Symptoms can be:

• Feeling more thirsty.
• More frequent urination.
• Feeling hungrier. 
• Blurry vision.
• Headaches.
• Breath smelling like fruit.

All patients will have their blood sugar checked with blood tests. If you have diabetes and your blood sugars are higher than normal, talk to your provider. Tell your provider if you have any of these symptoms.

Some people may get a rash, scaly skin, or red, itchy bumps from this medication. Tell your provider if you notice any of these changes in your skin, since it could be a reaction. Your provider may suggest:

• Using an alcohol-free moisturizer on your skin and lips, and do not use moisturizers with perfumes or scents. 
• Keep the area clean to avoid infection, especially if it cracks or bleeds.
• Using a topical medication (applied to the skin) if the itching bothers you.

Be sure to talk with your provider about how to care for your skin.

Diarrhea is when you pass three or more stools in a day. Your providers can suggest medications to relieve diarrhea. Do not take any medications to manage your diarrhea without talking to your provider first, as your stool may need to be tested. To manage it, try eating foods that are low in fiber and bland, like white rice and boiled or baked chicken. Try not to eat raw fruits, vegetables, whole grain breads, cereals, and seeds. Soluble fiber is a type of fiber found in some foods that helps absorb (soak up) fluid. Foods high in soluble fiber are applesauce, bananas (ripe), canned fruit, oranges, boiled potatoes, white rice, foods made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Stay hydrated by drinking 8 to 10 glasses of non-alcoholic, non-caffeinated fluid each day.

If you notice you are bleeding more easily or for no reason, especially new bleeding from your gums or nose, call your provider right away. You may also bruise more easily.

If you have bright red or dark, tarry stool, blood in your vomit, vomit that looks like coffee grounds, or have any signs of stroke (severe headache, trouble talking, weakness on one side, confusion), call 911 right away. 

Talk to your providers if you have nausea and/or vomiting. They can prescribe medications to help you. Making changes to your diet can also help. Avoid things that make your symptoms worse, like heavy or greasy/fatty foods and spicy or acidic foods, like tomatoes, lemons, and oranges. Try saltines or ginger ale to help your symptoms.  

Call your providers if you cannot keep fluids down for more than 12 hours or if you feel lightheaded or dizzy.

You may have joint or muscle pain/aches and headaches while taking this medication. Your provider can recommend medications and other ways to help relieve your pain.

This medication can make your skin more sensitive to the sun, which can result in a severe sunburn or rash. Sun sensitivity can last even after you are done with chemotherapy. Avoid the sun between 10 am and 4 pm, when it is strongest. Wear sunscreen every day and reapply when you are in the sun. The best sunscreen is SPF 30 or higher and protects against both types of sunlight, UVA and UVB. Wear sunglasses, a hat, and long sleeves/pants to protect your skin, a lip balm with SPF greater than 30, and seek out shade whenever possible.

Tell your providers if you develop red, painful, or itchy skin, sunburn, skin irritation, bumps, or thick, dry skin.

This medication may affect your fertility. It can cause changes to your menstrual cycle or sperm. You may want to consider sperm banking or egg harvesting if you might wish to have a child in the future. Talk about your options with your provider before treatment.

There is a higher risk of health problems for your baby if you are pregnant, become pregnant, or get someone pregnant while on this medication. To lower the risk of birth defects, you should use birth control (contraception) to avoid pregnancy. Talk with your provider about what kind of birth control is safest for you and your partner.